How painful is facial local anesthetic injections?

[yimlitnoy]

I need surgery for upper and lower lid Blepharoplasty.  Many patients are complaining about the pain caused by the local anesthetic injections, some say it is like a bee sting, a nurse who worked in the operating room and had the surgery on herself before told me that it can be compared to scorpion sting.  Now I am scared and I do not know the level of pain as nobody could give me an adequate comparative example, is it a burning pain, stinging sensation, acid pain sensation?  To me a bee sting or scorpion sting is quite a lot of pain.

 

Some nurses told me that generally patients tolerate the procedure quite well but when I asked former patients each one told me about a lot of pain, they say "very painful".  I hope somebody on this forum can alleviate my concern about the local anesthetic injections pain level, otherwise I will insist on general full anesthetic which is also double of the price.  Is there a way a surgeon can alleviate the pain?  Can someone help by describing their experience?

 

Why use an anesthetic that causes pain by itself?  Next I will also need cataract surgery.

 

Thank you

 

[Sheryl]

Have you ever had dental work with an anesthetic injection? Think of that as it would be comparable.

 

It is in no way like a scorpion sting because it is very brief - you feel just the initial entry of the needle and then the anesthetic itself soon puts a stop to that. There will be multiple inections, though.

 

A lot does depend on the skill of the doctor doing it. A skilful doc will numb one spot and then insert the subsequent needles through area already numb. You'll still feel it under the surface but not so bad.

 

I get facial injections of botox and fillers all the time. It is really not so bad .

 

If you get general anesthesia they are going to have to start an IV ion you, that will hurt at least as much.

 

It is a stinging pain and then there may be some  brief burning under the skin as the anesthetic diffuses. Both will be very brief as the anesthetic soon numbs everything.

 

[yimlitnoy]

Thank you Sheryl,

 

I have already done last week on Nov 10th the following under general anesthesia:

 

1. Lower lid blepharoplasty on both eyes.

2. Correction of entropion on both eyes.

 

Now they can proceed with the Cataract surgery of the right eye with IOL insertion next month.  I have already done the left eye 10 years ago also under general anesthesia. 

 

The upper lid blepharoplasty has to be done under local anesthetic due to the need to collaborate with the surgeon by closing and opening the upper lids for measurement.  In the past I had 4 retinal detachment operated in Canada, in Singapore and 2 of them in Bangkok.  So far so good, each time they improved my vision.  I am now 66 so I will not go for any botox as my appearance is not very important, the correction of entropion was the main objective before the next cataract surgery.

 

Thank you so much for the reassuring words, I might even consider the cataract surgery under local anesthesia this time...  maybe with some Voltaren.

 

 

[Sheryl]

There are no injections involved for the cataract surgery. They just instill numbing drops into the eye. It is completely painless.

[TerryLH]

"There are no injections involved for the cataract surgery. They just instill numbing drops into the eye. It is completely painless."

 

That might be true in some cases, but not all.  At least not just the drops.

I had cataract surgery on each eye earlier this year.

 

For the first eye they injected (lidocaine?) in the area under the eye.  Plus the drops, of course.

Enough pain that I wasn't looking forward to having the second eye done.

 

Since Piroxicam (Roxifen Gel) works for pain in my knee, I asked the doctor if I could use it on my face before they gave me any injections.  The doctor hadn't done that before, but thought it might work, so worth a try.  

 

The day of the surgery the nurse made sure I applied the gel to my satisfaction.  When the doctor came, she also inquired if I had put it on, and if it helped.  I told her I had, and there wasn't anywhere near the pain as the first time.

 

Whether it really worked, or not, didn't matter to me as the pain was less than I remembered from the first time.  So I consider it a win.

 

This was at Srinagarind (KKU).

For children they use a general.  For adults they use a local.  The doctor wants the adults awake so they can follow simple directions; look to the left, look up, etc.

 

 

 

[yimlitnoy]

Anti-inflammatory Voltaren Diclofenac pills or drops one hour before the surgery, will this help for cataract surgery? 

[Sheryl]

Should not pout in any drops before cataract surgery nor take meds except as prescribed.

 

People do not usually describe cataract surgery as painful, during or after.

[TerryLH]

"People do not usually describe cataract surgery as painful, during or after."

 

That was my experience, as well.  No pain during or after the surgery.

Just the pain of them injecting the pain killer prior to surgery.

[yimlitnoy]

1 hour ago, TerryLH said:

"People do not usually describe cataract surgery as painful, during or after."

 

That was my experience, as well.  No pain during or after the surgery.

Just the pain of them injecting the pain killer prior to surgery.

 

What kind of injection was it, retribulbar or peribulbar and was the injection very painful?

 

"A retrobulbar (i.e., behind eye) is an injection of an anesthetic placed behind the eye prior to the start of surgery. It is typically given with a 1.25 inch needle through the lower lid. This injection also anesthetizes the muscles that move the eye.  Peribulbar injections are given in two or three areas on the side of the eye with a shorter needle."  In the previous discussion, only local drops were considered.

[p_brownstone]

1 hour ago, TerryLH said:

"People do not usually describe cataract surgery as painful, during or after."

 

That was my experience, as well.  No pain during or after the surgery.

Just the pain of them injecting the pain killer prior to surgery.

 

I agree.

 

I had Cataract surgery here in Bangkok and the only painful part was the injection, below the eye socket.

 

Not at all unbearable but not particularly pleasant.

 

The surgery itself took perhaps 10 minutes and was completely painless, during and after.

 

Patrick

 

 

[wpcoe]

On 11/23/2016 at 6:52 PM, Sheryl said:

Should not pout in any drops before cataract surgery nor take meds except as prescribed.

 

People do not usually describe cataract surgery as painful, during or after.

 

Would it be appropriate for the doctor to prescribe a single-dose of an anti-anxiety drug like Valium to relax squeamish folks (like myself) before such a procedure?  I remember they gave me Valium before I had radial keratotomy surgery some 30 years ago to calm my nerves.

[Sheryl]

Up to the doctor, if I were the patient I would want it but with Thai doctors I don't know if they usually do this. If they do, the dosage will be extremely low. The problem is that Thais  are super-sensitive to any sort of sedative (2mg of valium will  literally knock them right out for hours). So the doctors may fear the patient being unable to cooperate with instructions.

 

Best top discuss with your doctor.

 

 

 

[wpcoe]

Thanks.   That's what I had assumed, but I know to not assume very much these days.  In fact, when I had my first RK surgery, the Valium dosage was too low -- and this was in the USA -- and I started to tense up and hyperventilate.  The nurse held my hand and coached my breathing.  For the other eye, they doubled the Valium dosage and I was as peaceful as could be.

[yimlitnoy]

Finally I was advised to have the cataract surgery under full general anesthetic saying that my eye is quite big and performing an injection under the eye has the risk of perforating it...